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This 79 year old patient had a history of regurgitating solid food, and was referred for a barium swallow. During the barium swallow it was obvious that the patient had a para-oesophageal hiatus hernia associated with organoaxial gastric volvulus. Further history revealed that this had previously been shown on a barium swallow of 4 years ago.
Gastric volvulus can be divided into organoaxial, mesenteroaxial and mixed types. Organoaxial volvulus is the most common, where the stomach is rotated around its longitudinal axis (along a line extending from cardia to pylorus). In organoaxial volvulus the stomach can twist either anteriorly or posteriorly. The antrum moves from an inferior to superior position. In primary gastric volvulus the stabilizing ligaments of the stomach are too lax due to congenital or acquired causes. Secondary gastric volvulus occurs with a para-oesophageal hernia. Organoaxial volvulus is typically observed in adults with a large hiatus hernia and complications are generally rare.
Federle et al. Diagnostic Imaging: Abdomen. Amirsys 2004.
Weisslander et al. Primer of Diagnostic Imaging. 3rd edition. Mosby 2003.
Credit: Dr Bernard Ng

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